Provider First Line Business Practice Location Address:
415 N MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULYSSES
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-356-1266
Provider Business Practice Location Address Fax Number:
620-356-6014
Provider Enumeration Date:
06/28/2006