Provider First Line Business Practice Location Address:
802 LAWRENCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-770-6844
Provider Business Practice Location Address Fax Number:
316-347-7898
Provider Enumeration Date:
01/02/2014