Provider First Line Business Practice Location Address:
510 E HWY 24
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAMEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-456-7366
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006