Provider First Line Business Practice Location Address:
111 E KANSAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCPHERSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67460-4851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-245-0146
Provider Business Practice Location Address Fax Number:
620-245-0994
Provider Enumeration Date:
10/16/2006