Provider First Line Business Practice Location Address:
1400 W 4TH STREET
Provider Second Line Business Practice Location Address:
COFFEYVILLE REGIONAL MEDICAL CENTER ER DEPARTMENT
Provider Business Practice Location Address City Name:
COFFEYVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-252-1649
Provider Business Practice Location Address Fax Number:
620-252-1699
Provider Enumeration Date:
12/06/2006