Provider First Line Business Practice Location Address:
1250 W AMITY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66053-7815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-837-4646
Provider Business Practice Location Address Fax Number:
913-837-4643
Provider Enumeration Date:
06/30/2008