Provider First Line Business Practice Location Address:
115 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67068-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-532-3134
Provider Business Practice Location Address Fax Number:
620-532-3251
Provider Enumeration Date:
09/14/2009