Provider First Line Business Practice Location Address:
212 SOUTH SUMMIT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARKANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-442-2300
Provider Business Practice Location Address Fax Number:
620-442-9498
Provider Enumeration Date:
11/09/2006