Provider First Line Business Practice Location Address:
921 E HIGHWAY 36
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITH CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66967-9582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-628-3231
Provider Business Practice Location Address Fax Number:
785-827-2515
Provider Enumeration Date:
11/19/2012