Provider First Line Business Practice Location Address:
804 E 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67439-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-472-5420
Provider Business Practice Location Address Fax Number:
785-472-8995
Provider Enumeration Date:
04/05/2006