Provider First Line Business Practice Location Address:
2727 IOWA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66046-4155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-832-8899
Provider Business Practice Location Address Fax Number:
785-832-8023
Provider Enumeration Date:
01/09/2007