Provider First Line Business Practice Location Address:
416 W SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNCTION CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66441-3627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-238-8162
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006