Provider First Line Business Practice Location Address:
1136 W 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-1800
Provider Business Practice Location Address Fax Number:
785-242-4078
Provider Enumeration Date:
02/27/2006