Provider First Line Business Practice Location Address:
222 W 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORDIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66901-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-243-3386
Provider Business Practice Location Address Fax Number:
785-243-4640
Provider Enumeration Date:
04/16/2020