Provider First Line Business Practice Location Address:
220 N PENNSYLVANIA AVE
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:
66725-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-782-2190
Provider Business Practice Location Address Fax Number:
417-782-6750
Provider Enumeration Date:
10/22/2007