Provider First Line Business Practice Location Address:
120 E 5TH AVE
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:
66801-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-4232
Provider Business Practice Location Address Fax Number:
620-341-4395
Provider Enumeration Date:
05/23/2005