Provider First Line Business Practice Location Address:
2619 W. 6TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-830-8299
Provider Business Practice Location Address Fax Number:
614-263-8268
Provider Enumeration Date:
04/18/2011