Provider First Line Business Practice Location Address:
1219 E 1ST ST STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67124-2081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-388-6277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2024