Provider First Line Business Practice Location Address:
623 COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-803-2855
Provider Business Practice Location Address Fax Number:
620-208-4488
Provider Enumeration Date:
12/16/2024