Provider First Line Business Practice Location Address:
711 BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66748-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-473-2289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2013