Provider First Line Business Practice Location Address:
2330 KANSAS AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LIBERAL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-624-2055
Provider Business Practice Location Address Fax Number:
620-624-2168
Provider Enumeration Date:
08/31/2006