Provider First Line Business Practice Location Address:
1022 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-532-8997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2005