Provider First Line Business Practice Location Address:
122 N DOUGLAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67439-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-342-1012
Provider Business Practice Location Address Fax Number:
785-225-6847
Provider Enumeration Date:
07/15/2008