Provider First Line Business Practice Location Address:
603 AMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWIN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66006-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-434-9399
Provider Business Practice Location Address Fax Number:
785-414-5335
Provider Enumeration Date:
08/28/2025