Provider First Line Business Practice Location Address:
1017 KENTUCKY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-331-2991
Provider Business Practice Location Address Fax Number:
785-843-3219
Provider Enumeration Date:
11/02/2006