Provider First Line Business Practice Location Address:
14TH AND OREGON STS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABETHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-2288
Provider Business Practice Location Address Fax Number:
785-284-1517
Provider Enumeration Date:
02/20/2006