Provider First Line Business Practice Location Address:
1415 JAYHAWK BLVD
Provider Second Line Business Practice Location Address:
KU PSYCHOLOGICAL CLINIC, FRASER HALL
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66045-7556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-864-9853
Provider Business Practice Location Address Fax Number:
785-864-5696
Provider Enumeration Date:
07/05/2006