Provider First Line Business Practice Location Address:
2120 W 25TH ST
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66047-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-856-1680
Provider Business Practice Location Address Fax Number:
785-856-0174
Provider Enumeration Date:
10/04/2010