Provider First Line Business Practice Location Address:
311 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEXTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67038-3805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-876-5415
Provider Business Practice Location Address Fax Number:
620-876-5548
Provider Enumeration Date:
09/14/2009