Provider First Line Business Practice Location Address:
101 E GREENWOOD AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67855-0699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-492-6230
Provider Business Practice Location Address Fax Number:
620-492-2309
Provider Enumeration Date:
10/05/2006