Provider First Line Business Practice Location Address:
2916 S 4TH ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66048-5016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-225-9340
Provider Business Practice Location Address Fax Number:
913-273-8484
Provider Enumeration Date:
09/22/2006