Provider First Line Business Practice Location Address:
1851 US HIGHWAY 50
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKIN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67860-0166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-355-8456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006