Provider First Line Business Practice Location Address:
910 W. 11TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORDIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66901-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-243-8140
Provider Business Practice Location Address Fax Number:
785-243-8149
Provider Enumeration Date:
05/25/2006