Provider First Line Business Practice Location Address:
2721 W SIXTH STREET
Provider Second Line Business Practice Location Address:
SUITE D
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:
785-832-9355
Provider Business Practice Location Address Fax Number:
785-832-9356
Provider Enumeration Date:
09/28/2006