Provider First Line Business Practice Location Address:
500 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-3552
Provider Business Practice Location Address Fax Number:
316-212-0374
Provider Enumeration Date:
10/19/2006