Provider First Line Business Practice Location Address:
5950 SW 28TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66614-2540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-272-5904
Provider Business Practice Location Address Fax Number:
785-272-0136
Provider Enumeration Date:
11/30/2007