Provider First Line Business Practice Location Address:
420 COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-7447
Provider Business Practice Location Address Fax Number:
620-672-6236
Provider Enumeration Date:
07/12/2017