Provider First Line Business Practice Location Address:
1829 COLLEGE 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:
66502-3381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-776-5100
Provider Business Practice Location Address Fax Number:
785-776-5101
Provider Enumeration Date:
12/07/2005