Provider First Line Business Practice Location Address:
511 PARAMOUNT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SABETHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66534-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-284-3471
Provider Business Practice Location Address Fax Number:
785-284-3697
Provider Enumeration Date:
10/17/2007