Provider First Line Business Practice Location Address:
1601 WEST 16TH STREET
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:
67152-8125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-326-7448
Provider Business Practice Location Address Fax Number:
620-326-6662
Provider Enumeration Date:
07/21/2006