Provider First Line Business Practice Location Address:
103 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSBORNE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67473-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-346-2136
Provider Business Practice Location Address Fax Number:
785-346-5898
Provider Enumeration Date:
09/27/2007