Provider First Line Business Practice Location Address:
625 KENTUCKY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67831-3199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-635-2241
Provider Business Practice Location Address Fax Number:
620-635-2229
Provider Enumeration Date:
10/30/2007