Provider First Line Business Practice Location Address:
306 E 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66046-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-843-4559
Provider Business Practice Location Address Fax Number:
785-843-1218
Provider Enumeration Date:
03/09/2006