Provider First Line Business Practice Location Address:
602 N 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846-5509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-272-2519
Provider Business Practice Location Address Fax Number:
620-272-2664
Provider Enumeration Date:
07/06/2006