Provider First Line Business Practice Location Address:
1315 N 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARKANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67005-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-446-0517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2026