Provider First Line Business Practice Location Address:
719 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67432-2936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-447-2983
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2009