Provider First Line Business Practice Location Address:
200 NORTH C STREET
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-326-7443
Provider Business Practice Location Address Fax Number:
620-326-8475
Provider Enumeration Date:
05/23/2005