Provider First Line Business Practice Location Address: 
3405 NW HUNTERS RIDGE TER
    Provider Second Line Business Practice Location Address: 
STE 300
    Provider Business Practice Location Address City Name: 
TOPEKA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66618-2509
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-246-2300
    Provider Business Practice Location Address Fax Number: 
785-246-2301
    Provider Enumeration Date: 
05/10/2017