Provider First Line Business Practice Location Address:
1655 AVENUE K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67439-4288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-472-4453
Provider Business Practice Location Address Fax Number:
785-472-5352
Provider Enumeration Date:
06/27/2006