Provider First Line Business Practice Location Address:
111 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66748-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-473-3008
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/09/2016