Provider First Line Business Practice Location Address:
119 EAST LINCOLN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-326-7983
Provider Business Practice Location Address Fax Number:
620-326-8094
Provider Enumeration Date:
10/03/2006