Provider First Line Business Practice Location Address:
210 E SAINT JOSEPH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATHENA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66090-1268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-989-4404
Provider Business Practice Location Address Fax Number:
785-989-3167
Provider Enumeration Date:
12/09/2019