Provider First Line Business Practice Location Address:
1354 N. MAIN, SUITE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCPHERSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-718-4707
Provider Business Practice Location Address Fax Number:
620-798-4265
Provider Enumeration Date:
02/14/2011