Provider First Line Business Practice Location Address:
112 E 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARNED
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67550-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-804-2691
Provider Business Practice Location Address Fax Number:
620-285-8996
Provider Enumeration Date:
12/29/2007