Provider First Line Business Practice Location Address:
1512 W 6TH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-1711
Provider Business Practice Location Address Fax Number:
620-341-5801
Provider Enumeration Date:
01/30/2009