Provider First Line Business Practice Location Address:
409 W BARTON RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEONARDVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-293-5244
Provider Business Practice Location Address Fax Number:
785-293-5574
Provider Enumeration Date:
08/30/2007