Provider First Line Business Practice Location Address:
113A S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULYSSES
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67880-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-424-1580
Provider Business Practice Location Address Fax Number:
620-271-0582
Provider Enumeration Date:
01/22/2015