Provider First Line Business Practice Location Address:
125 E PRAIRIE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GIRARD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66743-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-724-7220
Provider Business Practice Location Address Fax Number:
620-724-7221
Provider Enumeration Date:
07/20/2006