Provider First Line Business Practice Location Address:
216 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUCAS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67648-9124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-525-7788
Provider Business Practice Location Address Fax Number:
785-525-7786
Provider Enumeration Date:
07/29/2005