Provider First Line Business Practice Location Address:
1441 OREGON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABETHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66534-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-3411
Provider Business Practice Location Address Fax Number:
785-284-3444
Provider Enumeration Date:
07/07/2005