Provider First Line Business Practice Location Address:
101 S MCGEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANEY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67333-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-879-2622
Provider Business Practice Location Address Fax Number:
620-879-5821
Provider Enumeration Date:
04/23/2007