Provider First Line Business Practice Location Address:
2619 W. 6TH ST. SUITE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-830-8299
Provider Business Practice Location Address Fax Number:
785-749-2581
Provider Enumeration Date:
09/05/2006