Provider First Line Business Practice Location Address:
901 KENTUCKY ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-331-9824
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006