Provider First Line Business Practice Location Address:
3550 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-651-3300
Provider Business Practice Location Address Fax Number:
913-651-4101
Provider Enumeration Date:
03/07/2006