Provider First Line Business Practice Location Address:
217 S KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-429-1999
Provider Business Practice Location Address Fax Number:
620-429-1980
Provider Enumeration Date:
12/20/2010