Provider First Line Business Practice Location Address:
19 S HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANUTE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66720-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-431-4840
Provider Business Practice Location Address Fax Number:
620-431-4856
Provider Enumeration Date:
03/20/2007