Provider First Line Business Practice Location Address:
1112 W 6TH ST
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-749-1300
Provider Business Practice Location Address Fax Number:
785-749-4746
Provider Enumeration Date:
06/13/2006