Provider First Line Business Practice Location Address:
721 W KANSAS AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67054-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-723-3112
Provider Business Practice Location Address Fax Number:
620-723-3421
Provider Enumeration Date:
09/08/2014