Provider First Line Business Practice Location Address:
1020 MAIL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIOWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-825-4131
Provider Business Practice Location Address Fax Number:
620-825-4667
Provider Enumeration Date:
04/08/2006