Provider First Line Business Practice Location Address:
128 W KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITH CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66967-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-282-6086
Provider Business Practice Location Address Fax Number:
785-282-3978
Provider Enumeration Date:
12/09/2015