Provider First Line Business Practice Location Address: 
2400 SW 29TH
    Provider Second Line Business Practice Location Address: 
SUITE 224
    Provider Business Practice Location Address City Name: 
TOPEKA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66611-1738
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-267-6886
    Provider Business Practice Location Address Fax Number: 
785-267-3152
    Provider Enumeration Date: 
01/10/2006