Provider First Line Business Practice Location Address:
1112 WEST 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-2249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-840-9700
Provider Business Practice Location Address Fax Number:
785-840-9779
Provider Enumeration Date:
05/03/2006