Provider First Line Business Practice Location Address:
1133 COLLEGE AVENUE
Provider Second Line Business Practice Location Address:
SUITE D156
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-776-0450
Provider Business Practice Location Address Fax Number:
785-537-9504
Provider Enumeration Date:
02/13/2006