Provider First Line Business Practice Location Address:
1942 JUDSON ST
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:
66502-4922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-410-6855
Provider Business Practice Location Address Fax Number:
785-350-4688
Provider Enumeration Date:
04/24/2023