Provider First Line Business Practice Location Address:
423 HOUSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-6169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-587-4361
Provider Business Practice Location Address Fax Number:
785-587-2743
Provider Enumeration Date:
06/15/2006