Provider First Line Business Practice Location Address:
500 STATE HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAWATOMIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66064-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-755-7432
Provider Business Practice Location Address Fax Number:
913-755-7127
Provider Enumeration Date:
04/05/2010