Provider First Line Business Practice Location Address:
1110 N EMPORIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67214-2863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-269-4182
Provider Business Practice Location Address Fax Number:
316-269-0665
Provider Enumeration Date:
02/20/2007