Provider First Line Business Practice Location Address:
1215 MERCHANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-5002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-0121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2020