Provider First Line Business Practice Location Address:
601 MISSOURI ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-2361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-841-7430
Provider Business Practice Location Address Fax Number:
785-841-6411
Provider Enumeration Date:
06/01/2005