Provider First Line Business Practice Location Address:
206 1/2 S BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-308-5151
Provider Business Practice Location Address Fax Number:
620-308-1094
Provider Enumeration Date:
11/21/2006