Provider First Line Business Practice Location Address: 
330 SW OAKLEY AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TOPEKA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66606-1995
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-273-2252
    Provider Business Practice Location Address Fax Number: 
785-273-7489
    Provider Enumeration Date: 
08/31/2023