Provider First Line Business Practice Location Address:
1133 COLLEGE AVE. BLDG E-220
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:
66502-2777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-539-5341
Provider Business Practice Location Address Fax Number:
785-539-1238
Provider Enumeration Date:
04/20/2007