Provider First Line Business Practice Location Address:
4321 W 6TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-856-8218
Provider Business Practice Location Address Fax Number:
785-841-8281
Provider Enumeration Date:
12/22/2006