Provider First Line Business Practice Location Address:
101 SOUTH MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UDALL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-728-4080
Provider Business Practice Location Address Fax Number:
620-782-4082
Provider Enumeration Date:
03/10/2022