Provider First Line Business Practice Location Address:
428 N 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDONIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66736-1315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-378-2001
Provider Business Practice Location Address Fax Number:
620-378-4697
Provider Enumeration Date:
01/19/2006