Provider First Line Business Practice Location Address:
221 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL GROVE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66846-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-815-0466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2014