Provider First Line Business Practice Location Address:
2501 S SPRINGDALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-7315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-232-9090
Provider Business Practice Location Address Fax Number:
620-235-0215
Provider Enumeration Date:
02/22/2008