Provider First Line Business Practice Location Address:
104 S 4TH ST STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-6957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-367-8106
Provider Business Practice Location Address Fax Number:
785-706-5302
Provider Enumeration Date:
06/15/2026