Provider First Line Business Practice Location Address:
1640 CHARLES PL STE 103
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:
66502-2868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-776-9461
Provider Business Practice Location Address Fax Number:
785-776-9946
Provider Enumeration Date:
12/10/2007