Provider First Line Business Practice Location Address:
1106 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66748-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-743-2241
Provider Business Practice Location Address Fax Number:
620-743-3334
Provider Enumeration Date:
09/27/2023