Provider First Line Business Practice Location Address:
120 E 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-4649
Provider Business Practice Location Address Fax Number:
785-242-2401
Provider Enumeration Date:
01/30/2020