Provider First Line Business Practice Location Address:
401 S HIGH SCHOOL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTAMONT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67330-0189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-784-5326
Provider Business Practice Location Address Fax Number:
620-784-5879
Provider Enumeration Date:
02/06/2009