Provider First Line Business Practice Location Address:
310 SW 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67663-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-434-4565
Provider Business Practice Location Address Fax Number:
785-688-4105
Provider Enumeration Date:
01/14/2013