Provider First Line Business Practice Location Address:
616 MAIN ST.
Provider Second Line Business Practice Location Address:
BOX 778
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67548-0778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-222-2505
Provider Business Practice Location Address Fax Number:
785-222-3240
Provider Enumeration Date:
09/16/2009