Provider First Line Business Practice Location Address:
312 S MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNETT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-448-6988
Provider Business Practice Location Address Fax Number:
785-448-2243
Provider Enumeration Date:
05/17/2006