Provider First Line Business Practice Location Address:
200 COMMODORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-450-1443
Provider Business Practice Location Address Fax Number:
620-450-1895
Provider Enumeration Date:
02/28/2011