Provider First Line Business Practice Location Address:
401 E POYNTZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-5045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-776-4070
Provider Business Practice Location Address Fax Number:
785-776-1634
Provider Enumeration Date:
02/19/2010