Provider First Line Business Practice Location Address:
3400 S 4TH TRAFFICWAY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66048-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-651-1000
Provider Business Practice Location Address Fax Number:
913-651-3030
Provider Enumeration Date:
05/16/2007