Provider First Line Business Practice Location Address:
216 S JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITH CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66967-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-282-6665
Provider Business Practice Location Address Fax Number:
785-282-6518
Provider Enumeration Date:
09/14/2009