Provider First Line Business Practice Location Address:
1301 SUNNYSIDE AVE # 161
Provider Second Line Business Practice Location Address:
UNIVERSITY OF KANSAS
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66045-7567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-864-0799
Provider Business Practice Location Address Fax Number:
785-864-3343
Provider Enumeration Date:
07/20/2006