Provider First Line Business Practice Location Address:
2908 MILITARY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAXTER SPRINGS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66713-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-240-9221
Provider Business Practice Location Address Fax Number:
417-459-4791
Provider Enumeration Date:
04/08/2025