Provider First Line Business Practice Location Address:
724 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANTHONY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67003-2739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-842-5936
Provider Business Practice Location Address Fax Number:
620-842-3432
Provider Enumeration Date:
04/24/2012