Provider First Line Business Practice Location Address:
115 E 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARKANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67005-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-307-6122
Provider Business Practice Location Address Fax Number:
620-307-6127
Provider Enumeration Date:
04/24/2012