Provider First Line Business Practice Location Address:
914 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABETHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66534-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-2205
Provider Business Practice Location Address Fax Number:
785-284-2024
Provider Enumeration Date:
08/10/2005