Provider First Line Business Practice Location Address:
122 W RUTLEDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YATES CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66783-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-625-2221
Provider Business Practice Location Address Fax Number:
620-625-2453
Provider Enumeration Date:
07/16/2005