Provider First Line Business Practice Location Address:
1133 COLLEGE AVE
Provider Second Line Business Practice Location Address:
BLDG. D, SUITE 200
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-537-0136
Provider Business Practice Location Address Fax Number:
785-537-8591
Provider Enumeration Date:
01/25/2006