Provider First Line Business Practice Location Address:
330 ARKANSAS ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-749-0639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2007