Provider First Line Business Practice Location Address:
608 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67871-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-872-5774
Provider Business Practice Location Address Fax Number:
620-872-2314
Provider Enumeration Date:
05/30/2006