Provider First Line Business Practice Location Address:
122 E LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67152-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-326-5751
Provider Business Practice Location Address Fax Number:
620-326-7915
Provider Enumeration Date:
05/27/2006