Provider First Line Business Practice Location Address: 
6001 SW 6TH AVE
    Provider Second Line Business Practice Location Address: 
SUITE 115
    Provider Business Practice Location Address City Name: 
TOPEKA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66615-1011
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-271-2284
    Provider Business Practice Location Address Fax Number: 
785-271-2286
    Provider Enumeration Date: 
11/01/2006