Provider First Line Business Practice Location Address:
205 N 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ATWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67730-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-626-3236
Provider Business Practice Location Address Fax Number:
785-626-3083
Provider Enumeration Date:
10/05/2009