Provider First Line Business Practice Location Address:
225 SW 12TH ST RM 205
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:
66612-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-633-9453
Provider Business Practice Location Address Fax Number:
785-727-4006
Provider Enumeration Date:
01/28/2014