Provider First Line Business Practice Location Address:
330 ARKANSAS ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-840-2800
Provider Business Practice Location Address Fax Number:
785-840-2813
Provider Enumeration Date:
01/28/2008