Provider First Line Business Practice Location Address:
119 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66414-9628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-836-7500
Provider Business Practice Location Address Fax Number:
785-836-7500
Provider Enumeration Date:
05/24/2016