Provider First Line Business Practice Location Address:
109 N 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67301-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-423-0274
Provider Business Practice Location Address Fax Number:
620-423-8076
Provider Enumeration Date:
12/21/2022