Provider First Line Business Practice Location Address:
1417 W ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNCTION CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66441-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-762-2162
Provider Business Practice Location Address Fax Number:
785-762-5036
Provider Enumeration Date:
11/01/2005