Provider First Line Business Practice Location Address:
505 S PLUMMER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720-1950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-431-2500
Provider Business Practice Location Address Fax Number:
620-431-4418
Provider Enumeration Date:
11/08/2016