Provider First Line Business Practice Location Address:
115 S 18TH ST
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
PARSONS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67357-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-421-1073
Provider Business Practice Location Address Fax Number:
620-421-2824
Provider Enumeration Date:
12/19/2006