Provider First Line Business Practice Location Address:
415 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULYSSES
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67880-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-356-1266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2005