Provider First Line Business Practice Location Address:
423 NORTH WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOLA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-365-3991
Provider Business Practice Location Address Fax Number:
620-365-3999
Provider Enumeration Date:
09/07/2006