Provider First Line Business Practice Location Address:
3442 W 141ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66537-9444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-338-0031
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2007