Provider First Line Business Practice Location Address:
611 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLINWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67526-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-564-3771
Provider Business Practice Location Address Fax Number:
620-564-2491
Provider Enumeration Date:
11/07/2023