Provider First Line Business Practice Location Address:
146 N LAMAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYSVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67060-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-519-5097
Provider Business Practice Location Address Fax Number:
316-361-0679
Provider Enumeration Date:
03/13/2012