Provider First Line Business Practice Location Address:
302 E 4TH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-6969
Provider Business Practice Location Address Fax Number:
620-231-8018
Provider Enumeration Date:
09/21/2006