Provider First Line Business Practice Location Address:
20269 W HIGHWAY 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-8204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-5651
Provider Business Practice Location Address Fax Number:
620-672-9377
Provider Enumeration Date:
09/15/2009