Provider First Line Business Practice Location Address:
104 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKEENEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67672-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-743-2320
Provider Business Practice Location Address Fax Number:
785-743-5264
Provider Enumeration Date:
09/29/2006