Provider First Line Business Practice Location Address:
1101 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67871-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-872-2310
Provider Business Practice Location Address Fax Number:
620-872-7038
Provider Enumeration Date:
05/26/2007