Provider First Line Business Mailing Address:
1010 N KANSAS ST STE 3054A
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67214-3124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-962-3100
Provider Business Mailing Address Fax Number:
316-962-3132