Provider First Line Business Practice Location Address:
101 S. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLYROOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67450-9642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-252-3565
Provider Business Practice Location Address Fax Number:
785-252-3574
Provider Enumeration Date:
07/29/2005