Provider First Line Business Practice Location Address:
3101 SE ILLINOIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66605-2632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-551-1832
Provider Business Practice Location Address Fax Number:
785-215-8121
Provider Enumeration Date:
12/05/2025