Provider First Line Business Practice Location Address:
1505 SW FAIRLAWN RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66604-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-271-8614
Provider Business Practice Location Address Fax Number:
785-271-8615
Provider Enumeration Date:
09/14/2006