Provider First Line Business Practice Location Address:
1320 SO ASH
Provider Second Line Business Practice Location Address:
SUITE #206
Provider Business Practice Location Address City Name:
OTTAWA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66067-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-234-2277
Provider Business Practice Location Address Fax Number:
785-234-2396
Provider Enumeration Date:
01/11/2007