Provider First Line Business Practice Location Address:
1112 W 6TH ST STE 215
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:
66044-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-505-2250
Provider Business Practice Location Address Fax Number:
785-505-5259
Provider Enumeration Date:
08/28/2014