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:
67333-2179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-879-2386
Provider Business Practice Location Address Fax Number:
620-879-5651
Provider Enumeration Date:
03/20/2012