Provider First Line Business Practice Location Address:
2445 SW WANAMAKER RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66614-5470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-478-0221
Provider Business Practice Location Address Fax Number:
785-266-2208
Provider Enumeration Date:
11/14/2005