Provider First Line Business Practice Location Address:
506 HOWARD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66023-0022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-833-4025
Provider Business Practice Location Address Fax Number:
913-833-2960
Provider Enumeration Date:
05/05/2006