Provider First Line Business Practice Location Address:
14TH AND OREGON STREETS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABETHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66534-0229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-2121
Provider Business Practice Location Address Fax Number:
785-284-0550
Provider Enumeration Date:
06/30/2006