Provider First Line Business Practice Location Address:
1301 S. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-229-8200
Provider Business Practice Location Address Fax Number:
785-229-8930
Provider Enumeration Date:
03/12/2009