Provider First Line Business Practice Location Address:
1910 HASKELL AVENUE, SUITE 9
Provider Second Line Business Practice Location Address:
OBOT ROOM #100
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66046-3296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-856-4357
Provider Business Practice Location Address Fax Number:
785-856-1127
Provider Enumeration Date:
01/12/2023