Provider First Line Business Practice Location Address:
116 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-539-1017
Provider Business Practice Location Address Fax Number:
785-539-3097
Provider Enumeration Date:
07/01/2010