Provider First Line Business Practice Location Address:
1663 E US HIGHWAY 56
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66414-9178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-665-7168
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2009