Provider First Line Business Practice Location Address:
2401 S TUCKER AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-6619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-2490
Provider Business Practice Location Address Fax Number:
620-231-3920
Provider Enumeration Date:
11/14/2006