Provider First Line Business Practice Location Address:
2706 IOWA ST
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66046-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-842-2211
Provider Business Practice Location Address Fax Number:
785-842-2276
Provider Enumeration Date:
10/12/2006