Provider First Line Business Practice Location Address:
623 W 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701-2260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-644-2438
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2022