Provider First Line Business Practice Location Address:
1724 SW 48TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-8792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-282-0099
Provider Business Practice Location Address Fax Number:
316-282-0916
Provider Enumeration Date:
06/17/2007