Provider First Line Business Practice Location Address:
2401 N SETH CHILD RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66503-8817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-539-1017
Provider Business Practice Location Address Fax Number:
785-539-3097
Provider Enumeration Date:
07/30/2013