Provider First Line Business Practice Location Address:
501 S NINNESCAH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-7546
Provider Business Practice Location Address Fax Number:
620-672-7148
Provider Enumeration Date:
04/19/2017