Provider First Line Business Practice Location Address:
101 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67855-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-635-5250
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2009