Provider First Line Business Practice Location Address:
2711 S. ROUSE ST., STE A
Provider Second Line Business Practice Location Address:
MT. CARMEL PLAZA
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-230-0035
Provider Business Practice Location Address Fax Number:
620-230-0035
Provider Enumeration Date:
03/01/2012