Provider First Line Business Practice Location Address:
1210 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67663-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-688-4435
Provider Business Practice Location Address Fax Number:
785-434-2434
Provider Enumeration Date:
07/12/2005