Provider First Line Business Practice Location Address:
930 IOWA STREET
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-842-1242
Provider Business Practice Location Address Fax Number:
785-842-3557
Provider Enumeration Date:
02/26/2006