Provider First Line Business Practice Location Address:
5006 N DODGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEALY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67850-5022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-398-2248
Provider Business Practice Location Address Fax Number:
620-398-2435
Provider Enumeration Date:
10/01/2009