Provider First Line Business Practice Location Address:
205 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-6166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-587-8818
Provider Business Practice Location Address Fax Number:
785-587-8946
Provider Enumeration Date:
08/04/2011