Provider First Line Business Practice Location Address:
801 S FRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YATES CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66783-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-625-2111
Provider Business Practice Location Address Fax Number:
620-625-3630
Provider Enumeration Date:
01/24/2011