Provider First Line Business Practice Location Address:
104 N WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67152-3949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-326-2100
Provider Business Practice Location Address Fax Number:
620-399-8319
Provider Enumeration Date:
07/14/2006