Provider First Line Business Practice Location Address:
134 S MAIN 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:
66067-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-2055
Provider Business Practice Location Address Fax Number:
785-242-0649
Provider Enumeration Date:
08/27/2019