Provider First Line Business Practice Location Address:
203 WATSON ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-3092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-7422
Provider Business Practice Location Address Fax Number:
620-508-6476
Provider Enumeration Date:
02/14/2013