Provider First Line Business Practice Location Address:
3111 W 6TH 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:
66049-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-841-5288
Provider Business Practice Location Address Fax Number:
785-749-2323
Provider Enumeration Date:
07/18/2005