Provider First Line Business Practice Location Address:
324 SAINT JOSEPH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATHENA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66090-1280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-989-4644
Provider Business Practice Location Address Fax Number:
785-989-4660
Provider Enumeration Date:
06/13/2007