Provider First Line Business Practice Location Address:
431 POYNTZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-0115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-776-8833
Provider Business Practice Location Address Fax Number:
785-776-3784
Provider Enumeration Date:
02/08/2019