Provider First Line Business Practice Location Address:
1010 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORDIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66901-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-243-4236
Provider Business Practice Location Address Fax Number:
316-283-9540
Provider Enumeration Date:
03/20/2007