Provider First Line Business Practice Location Address:
212 SOUTH 4TH STREET
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-323-0644
Provider Business Practice Location Address Fax Number:
785-323-0643
Provider Enumeration Date:
03/07/2014