Provider First Line Business Practice Location Address:
1210 N WASHINGTON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-434-4553
Provider Business Practice Location Address Fax Number:
785-434-2434
Provider Enumeration Date:
03/29/2007