Provider First Line Business Practice Location Address:
112 S. 4TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEODESHA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66757-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-325-2642
Provider Business Practice Location Address Fax Number:
620-325-5018
Provider Enumeration Date:
09/27/2006