Provider First Line Business Practice Location Address:
3066 N KENTUCKY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOLA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-365-1185
Provider Business Practice Location Address Fax Number:
620-365-1038
Provider Enumeration Date:
03/14/2016