Provider First Line Business Practice Location Address:
2132 N KANSAS AVENUE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LIBERAL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-624-1530
Provider Business Practice Location Address Fax Number:
620-624-3210
Provider Enumeration Date:
03/30/2007