Provider First Line Business Practice Location Address:
501 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAWATOMIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66064-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-755-2070
Provider Business Practice Location Address Fax Number:
913-642-1554
Provider Enumeration Date:
01/28/2008