Provider First Line Business Practice Location Address:
1800 E 4TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-8573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-232-2990
Provider Business Practice Location Address Fax Number:
620-232-2844
Provider Enumeration Date:
08/03/2011