Provider First Line Business Practice Location Address:
1014 POYNTZ AVE STE C
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:
66502-6758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-320-5151
Provider Business Practice Location Address Fax Number:
785-320-5159
Provider Enumeration Date:
08/21/2013