Provider First Line Business Practice Location Address:
2502 N JOHN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-271-0243
Provider Business Practice Location Address Fax Number:
620-271-0218
Provider Enumeration Date:
06/01/2007