Provider First Line Business Practice Location Address: 
102 N MAIN ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ARGONIA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
67004
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
620-435-6356
    Provider Business Practice Location Address Fax Number: 
620-435-6169
    Provider Enumeration Date: 
04/05/2006