Provider First Line Business Practice Location Address:
4500 S KANSAS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67871-5139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-874-1565
Provider Business Practice Location Address Fax Number:
620-275-6582
Provider Enumeration Date:
05/16/2007