Provider First Line Business Practice Location Address:
210 W FIRST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST FRANCIS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67756-0547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-332-2104
Provider Business Practice Location Address Fax Number:
785-332-3255
Provider Enumeration Date:
05/22/2007