Provider First Line Business Practice Location Address:
1133 COLLEGE AVENUE
Provider Second Line Business Practice Location Address:
BUILDING D, SUITE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-770-3300
Provider Business Practice Location Address Fax Number:
785-770-3941
Provider Enumeration Date:
05/07/2007