Provider First Line Business Practice Location Address:
800 W 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-431-2820
Provider Business Practice Location Address Fax Number:
620-431-0082
Provider Enumeration Date:
07/29/2014