Provider First Line Business Practice Location Address:
629 S PLUMMER AVE
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:
66720-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-321-5900
Provider Business Practice Location Address Fax Number:
316-321-4763
Provider Enumeration Date:
09/01/2006