Provider First Line Business Practice Location Address:
1010 S COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67356-9013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-795-4750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2006