Provider First Line Business Practice Location Address:
1212 WALNUT 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:
66066-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-863-2447
Provider Business Practice Location Address Fax Number:
785-863-2652
Provider Enumeration Date:
07/11/2005