Provider First Line Business Practice Location Address:
348 NE SR 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-450-2151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007