Provider First Line Business Practice Location Address:
113 S MAIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULYSSES
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67880-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-356-2432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2005