Provider First Line Business Practice Location Address:
1133 COLLEGE AVE STE D200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-539-0800
Provider Business Practice Location Address Fax Number:
785-539-0811
Provider Enumeration Date:
09/25/2006