Provider First Line Business Practice Location Address:
111 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-8970
Provider Business Practice Location Address Fax Number:
785-242-6770
Provider Enumeration Date:
07/13/2006