Provider First Line Business Practice Location Address:
110 E 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67871-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-874-4868
Provider Business Practice Location Address Fax Number:
620-872-5014
Provider Enumeration Date:
07/03/2006