Provider First Line Business Practice Location Address:
702 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66935-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-527-2146
Provider Business Practice Location Address Fax Number:
785-527-5528
Provider Enumeration Date:
08/10/2005