Provider First Line Business Practice Location Address:
204 W 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-843-2039
Provider Business Practice Location Address Fax Number:
785-749-5064
Provider Enumeration Date:
01/24/2012