Provider First Line Business Practice Location Address:
2003 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-8460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-672-7525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2018