Provider First Line Business Practice Location Address:
501 W CENTRAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66725-9211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-429-1949
Provider Business Practice Location Address Fax Number:
620-429-1982
Provider Enumeration Date:
03/27/2007