Provider First Line Business Practice Location Address:
504 E. 4TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONGANOXIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-841-8210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2009