Provider First Line Business Practice Location Address: 
1500 SW 10TH AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TOPEKA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66604-1301
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-354-6440
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/12/2006