Provider First Line Business Practice Location Address:
826 18TH STREET SUITE A
Provider Second Line Business Practice Location Address:
PO BOX 415
Provider Business Practice Location Address City Name:
HOXIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67740-0415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-675-3018
Provider Business Practice Location Address Fax Number:
785-675-2306
Provider Enumeration Date:
05/31/2006