Provider First Line Business Practice Location Address:
108 N. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-532-2225
Provider Business Practice Location Address Fax Number:
620-532-3621
Provider Enumeration Date:
09/21/2006