Provider First Line Business Practice Location Address:
240 WEST 4TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNETT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-448-3422
Provider Business Practice Location Address Fax Number:
785-448-3070
Provider Enumeration Date:
10/03/2006