Provider First Line Business Practice Location Address: 
1835 NW TOPEKA BLVD STE 205
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TOPEKA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66608-1892
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-286-2273
    Provider Business Practice Location Address Fax Number: 
785-232-8618
    Provider Enumeration Date: 
12/04/2014