Provider First Line Business Practice Location Address:
1133 COLLEGE AVE
Provider Second Line Business Practice Location Address:
STE E230
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-537-4990
Provider Business Practice Location Address Fax Number:
785-537-1938
Provider Enumeration Date:
05/31/2005