Provider First Line Business Practice Location Address:
120 E 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-665-0528
Provider Business Practice Location Address Fax Number:
620-665-0062
Provider Enumeration Date:
10/26/2016