Provider First Line Business Practice Location Address:
619 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67432-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-630-5500
Provider Business Practice Location Address Fax Number:
785-630-5295
Provider Enumeration Date:
02/01/2022