Provider First Line Business Practice Location Address:
402 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKIN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67860-6812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-355-6342
Provider Business Practice Location Address Fax Number:
620-355-7129
Provider Enumeration Date:
10/24/2011