Provider First Line Business Practice Location Address:
614 MERCHANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-212-3832
Provider Business Practice Location Address Fax Number:
620-679-1850
Provider Enumeration Date:
12/09/2022