Provider First Line Business Practice Location Address:
1112 W 6TH ST STE 216
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-2249
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:
07/27/2006