Provider First Line Business Practice Location Address:
1696 LONGHORN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YATES CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66783-4443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-625-5246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2015