Provider First Line Business Practice Location Address: 
3707 SW 6TH AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TOPEKA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66606-2084
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-270-4630
    Provider Business Practice Location Address Fax Number: 
785-270-4628
    Provider Enumeration Date: 
02/17/2006