Provider First Line Business Practice Location Address:
630 HUMBOLDT ST
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-6095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-799-5666
Provider Business Practice Location Address Fax Number:
785-396-4399
Provider Enumeration Date:
06/12/2020