Provider First Line Business Practice Location Address:
113 N ANTHONY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67003-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-842-3844
Provider Business Practice Location Address Fax Number:
620-842-4139
Provider Enumeration Date:
03/29/2006