Provider First Line Business Practice Location Address:
742 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67661-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-543-0625
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006