Provider First Line Business Practice Location Address:
1719 HWY 183
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67661-0547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-543-5211
Provider Business Practice Location Address Fax Number:
785-543-5274
Provider Enumeration Date:
11/02/2006