Provider First Line Business Practice Location Address:
104 E 4TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON SPRINGS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67758-9715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-852-4272
Provider Business Practice Location Address Fax Number:
785-852-4249
Provider Enumeration Date:
10/18/2006