Provider First Line Business Practice Location Address:
1310 W ASH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
JUNCTION CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66441-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-762-2653
Provider Business Practice Location Address Fax Number:
785-238-2685
Provider Enumeration Date:
06/14/2005