Provider First Line Business Practice Location Address:
125 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAKEENEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67672-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-743-5753
Provider Business Practice Location Address Fax Number:
785-743-5858
Provider Enumeration Date:
02/25/2015