Provider First Line Business Practice Location Address:
1501 WEST 7TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-432-5775
Provider Business Practice Location Address Fax Number:
620-431-1106
Provider Enumeration Date:
08/03/2006