Provider First Line Business Practice Location Address:
924 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67432-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-632-5646
Provider Business Practice Location Address Fax Number:
785-632-5874
Provider Enumeration Date:
09/07/2006