Provider First Line Business Practice Location Address:
104 E COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66548-8918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-363-2425
Provider Business Practice Location Address Fax Number:
785-363-2425
Provider Enumeration Date:
07/05/2006