Provider First Line Business Practice Location Address:
2410 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PARSONS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67357-2747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-421-6767
Provider Business Practice Location Address Fax Number:
620-421-6766
Provider Enumeration Date:
02/24/2009