Provider First Line Business Practice Location Address:
710 COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-6643
Provider Business Practice Location Address Fax Number:
342-343-3361
Provider Enumeration Date:
06/11/2007