Provider First Line Business Practice Location Address:
303 W KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDICINE LODGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67104-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-409-0095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2022