Provider First Line Business Practice Location Address:
615 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66748-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-473-3456
Provider Business Practice Location Address Fax Number:
620-473-2299
Provider Enumeration Date:
03/18/2007