Provider First Line Business Practice Location Address:
1901 EAST FIRST STREET
Provider Second Line Business Practice Location Address:
PRAIRIE VIEW
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-0467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-281-6700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2007