Provider First Line Business Practice Location Address:
900 E LOGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-2056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-2067
Provider Business Practice Location Address Fax Number:
785-242-2068
Provider Enumeration Date:
04/27/2015