Provider First Line Business Practice Location Address:
2348 IOWA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-842-5555
Provider Business Practice Location Address Fax Number:
785-749-1612
Provider Enumeration Date:
08/21/2006