Provider First Line Business Practice Location Address:
1640 CHARLES PLACE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-537-8484
Provider Business Practice Location Address Fax Number:
785-537-2281
Provider Enumeration Date:
12/18/2006