Provider First Line Business Practice Location Address:
2706 IOWA
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-832-2828
Provider Business Practice Location Address Fax Number:
785-832-2828
Provider Enumeration Date:
09/21/2006