Provider First Line Business Practice Location Address:
1501 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720-2551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-433-3838
Provider Business Practice Location Address Fax Number:
620-431-5827
Provider Enumeration Date:
03/13/2007