Provider First Line Business Practice Location Address:
2330 N KANSAS AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
LIBERAL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67901-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-624-7773
Provider Business Practice Location Address Fax Number:
620-626-7396
Provider Enumeration Date:
11/24/2008