Provider First Line Business Practice Location Address:
1012 POPLAR STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-883-4401
Provider Business Practice Location Address Fax Number:
785-883-4401
Provider Enumeration Date:
10/03/2006