Provider First Line Business Practice Location Address:
1640 CHARLES PL
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-0428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-539-4645
Provider Business Practice Location Address Fax Number:
785-539-1655
Provider Enumeration Date:
01/09/2009