Provider First Line Business Practice Location Address:
37 BALL PARK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
40831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-4520
Provider Business Practice Location Address Fax Number:
606-574-8457
Provider Enumeration Date:
08/18/2006