Provider First Line Business Practice Location Address:
1025 N 3RD ST
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-1429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-331-0807
Provider Business Practice Location Address Fax Number:
785-331-0878
Provider Enumeration Date:
05/30/2006