Provider First Line Business Practice Location Address:
1133 COLLEGE AVENUE
Provider Second Line Business Practice Location Address:
G200
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-320-6616
Provider Business Practice Location Address Fax Number:
785-320-6667
Provider Enumeration Date:
08/31/2006