Provider First Line Business Practice Location Address:
1133 COLLEGE AVE STE G
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-537-0304
Provider Business Practice Location Address Fax Number:
785-539-4710
Provider Enumeration Date:
03/26/2010