Provider First Line Business Practice Location Address:
424 S MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701-2697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-223-0800
Provider Business Practice Location Address Fax Number:
620-223-6420
Provider Enumeration Date:
07/19/2006