Provider First Line Business Practice Location Address:
1201 W 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-6800
Provider Business Practice Location Address Fax Number:
620-341-7821
Provider Enumeration Date:
07/18/2006