Provider First Line Business Practice Location Address:
212 E 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-4046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-235-7151
Provider Business Practice Location Address Fax Number:
620-235-7154
Provider Enumeration Date:
09/18/2007