Provider First Line Business Practice Location Address: 
2100 WATKINS HEALTH CTR
    Provider Second Line Business Practice Location Address: 
1200 SCHWEGLER DRIVE
    Provider Business Practice Location Address City Name: 
LAWRENCE
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66045-7559
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
785-864-2277
    Provider Business Practice Location Address Fax Number: 
785-864-2721
    Provider Enumeration Date: 
02/14/2007