Provider First Line Business Practice Location Address:
311 J E HUMPHREYS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67831-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-635-2220
Provider Business Practice Location Address Fax Number:
620-635-2637
Provider Enumeration Date:
09/15/2009