Provider First Line Business Practice Location Address:
219 E 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-229-7300
Provider Business Practice Location Address Fax Number:
785-229-7310
Provider Enumeration Date:
11/15/2005