Provider First Line Business Practice Location Address:
930 IOWA ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-843-6404
Provider Business Practice Location Address Fax Number:
785-865-5617
Provider Enumeration Date:
06/18/2008