Provider First Line Business Practice Location Address:
1428 S MAIN ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-229-8232
Provider Business Practice Location Address Fax Number:
785-248-2899
Provider Enumeration Date:
12/21/2020