Provider First Line Business Practice Location Address:
302 E 4TH ST
Provider Second Line Business Practice Location Address:
STE. E
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-232-6555
Provider Business Practice Location Address Fax Number:
620-232-6699
Provider Enumeration Date:
01/02/2008