Provider First Line Business Practice Location Address:
1301 WEST 12TH AVE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-0970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-2521
Provider Business Practice Location Address Fax Number:
620-342-6520
Provider Enumeration Date:
07/03/2006