Provider First Line Business Practice Location Address:
1112 W 6TH ST
Provider Second Line Business Practice Location Address:
STE 216
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-841-1107
Provider Business Practice Location Address Fax Number:
785-841-1173
Provider Enumeration Date:
09/30/2008