Provider First Line Business Practice Location Address:
1156 HIGHWAY 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67439-8661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-472-3167
Provider Business Practice Location Address Fax Number:
785-472-5440
Provider Enumeration Date:
10/26/2005