Provider First Line Business Practice Location Address:
1305 E KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-275-1957
Provider Business Practice Location Address Fax Number:
620-272-8218
Provider Enumeration Date:
06/07/2006