Provider First Line Business Practice Location Address:
1005 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLIS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67637-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-726-3452
Provider Business Practice Location Address Fax Number:
785-726-4007
Provider Enumeration Date:
12/09/2011