Provider First Line Business Practice Location Address:
222 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-223-6221
Provider Business Practice Location Address Fax Number:
620-223-3375
Provider Enumeration Date:
04/04/2007