Provider First Line Business Practice Location Address:
101 W BUTLER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YATES CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66783-1259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-625-8804
Provider Business Practice Location Address Fax Number:
620-625-8806
Provider Enumeration Date:
09/16/2009