Provider First Line Business Practice Location Address:
2512 W 6TH ST STE C
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-856-6789
Provider Business Practice Location Address Fax Number:
785-856-4050
Provider Enumeration Date:
01/16/2007