Provider First Line Business Practice Location Address:
3252 KIMBALL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66503-2157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-539-9255
Provider Business Practice Location Address Fax Number:
785-539-2494
Provider Enumeration Date:
03/09/2007