Provider First Line Business Practice Location Address:
1811 WAKARUSA DR. SUITE 101
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-424-4441
Provider Business Practice Location Address Fax Number:
913-624-3848
Provider Enumeration Date:
11/30/2006