Provider First Line Business Practice Location Address:
207 E PRAIRIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIRARD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66743-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-724-6725
Provider Business Practice Location Address Fax Number:
620-223-2374
Provider Enumeration Date:
07/08/2005