Provider First Line Business Practice Location Address:
608 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAMEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66547-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-844-1144
Provider Business Practice Location Address Fax Number:
785-537-2573
Provider Enumeration Date:
09/16/2008