Provider First Line Business Practice Location Address:
118 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-508-6400
Provider Business Practice Location Address Fax Number:
620-508-6401
Provider Enumeration Date:
01/02/2014