Provider First Line Business Practice Location Address:
1201 STATE HIGHWAY 99
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOWARD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67349-0607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-374-2113
Provider Business Practice Location Address Fax Number:
620-374-2414
Provider Enumeration Date:
07/24/2006