Provider First Line Business Practice Location Address:
1122 N TOPEKA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67214-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-866-2000
Provider Business Practice Location Address Fax Number:
316-866-2084
Provider Enumeration Date:
02/24/2026