Provider First Line Business Practice Location Address:
111 W MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67663-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-434-4678
Provider Business Practice Location Address Fax Number:
785-434-7404
Provider Enumeration Date:
10/19/2009