Provider First Line Business Practice Location Address:
715 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-9056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-6655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2005