Provider First Line Business Practice Location Address:
501 SE 36TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-8730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-284-2930
Provider Business Practice Location Address Fax Number:
316-284-2141
Provider Enumeration Date:
01/27/2006