Provider First Line Business Practice Location Address:
118 W STEADMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67003-2950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-213-1352
Provider Business Practice Location Address Fax Number:
620-842-3728
Provider Enumeration Date:
06/11/2014