Provider First Line Business Practice Location Address:
221 W LOGAN 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:
66801-4661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-4212
Provider Business Practice Location Address Fax Number:
620-342-6523
Provider Enumeration Date:
09/28/2006