Provider First Line Business Practice Location Address:
800 BARKER DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSWEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-795-2119
Provider Business Practice Location Address Fax Number:
620-795-2357
Provider Enumeration Date:
01/06/2010