Provider First Line Business Practice Location Address:
304 E AVE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-384-7882
Provider Business Practice Location Address Fax Number:
620-384-3858
Provider Enumeration Date:
09/22/2006