Provider First Line Business Practice Location Address:
204 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEXTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-876-5863
Provider Business Practice Location Address Fax Number:
620-876-5865
Provider Enumeration Date:
08/17/2005