Provider First Line Business Practice Location Address:
639 NE FREEMAN AVE
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:
66616-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-249-8866
Provider Business Practice Location Address Fax Number:
785-249-8866
Provider Enumeration Date:
06/29/2026