Provider First Line Business Practice Location Address:
321 JEFFERSON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSKALOOSA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-863-2063
Provider Business Practice Location Address Fax Number:
913-863-2074
Provider Enumeration Date:
06/19/2007