Provider First Line Business Practice Location Address:
5827 SW 47TH ST
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:
66610-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-230-4856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2025