Provider First Line Business Practice Location Address:
1101 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLIS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67637-1757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-896-6400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2008