Provider First Line Business Practice Location Address:
218 W RUTLEDGE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
YATES CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66783-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-625-3311
Provider Business Practice Location Address Fax Number:
320-325-2446
Provider Enumeration Date:
12/27/2021