Provider First Line Business Practice Location Address:
1920 MILITARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAXTER SPRINGS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66713-2039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-856-5555
Provider Business Practice Location Address Fax Number:
620-856-3455
Provider Enumeration Date:
08/31/2006