Provider First Line Business Practice Location Address:
23750 STATE LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66053-7245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-837-0230
Provider Business Practice Location Address Fax Number:
913-947-3206
Provider Enumeration Date:
12/18/2014