Provider First Line Business Practice Location Address:
1623 POYNTZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-4148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-477-5534
Provider Business Practice Location Address Fax Number:
888-320-6292
Provider Enumeration Date:
08/22/2024