Provider First Line Business Practice Location Address:
535 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66523-1157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-528-4322
Provider Business Practice Location Address Fax Number:
785-528-3357
Provider Enumeration Date:
09/13/2006