Provider First Line Business Practice Location Address:
5501 SW 29TH ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66614-2479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-272-5544
Provider Business Practice Location Address Fax Number:
785-272-0275
Provider Enumeration Date:
03/23/2007