Provider First Line Business Practice Location Address:
2534 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-9555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-8882
Provider Business Practice Location Address Fax Number:
785-242-8305
Provider Enumeration Date:
11/17/2006