Provider First Line Business Practice Location Address:
1275 S FRANKLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLBY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67701-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-460-4585
Provider Business Practice Location Address Fax Number:
785-460-4586
Provider Enumeration Date:
09/15/2005