Provider First Line Business Practice Location Address:
1133 COLLEGE AVE
Provider Second Line Business Practice Location Address:
SUITE C145
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-320-7388
Provider Business Practice Location Address Fax Number:
785-320-6056
Provider Enumeration Date:
05/28/2013