Provider First Line Business Practice Location Address:
109 W 2ND ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-242-2991
Provider Business Practice Location Address Fax Number:
785-242-4401
Provider Enumeration Date:
12/07/2021