Provider First Line Business Practice Location Address:
402 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67869-9772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-563-9313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2005