Provider First Line Business Practice Location Address:
100 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSKALOOSA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66066-4168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-841-7297
Provider Business Practice Location Address Fax Number:
785-856-0375
Provider Enumeration Date:
08/23/2016