Provider First Line Business Practice Location Address:
107 E MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSBORNE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-346-5434
Provider Business Practice Location Address Fax Number:
785-346-5703
Provider Enumeration Date:
07/13/2006