Provider First Line Business Practice Location Address:
205 S 4TH ST
Provider Second Line Business Practice Location Address:
SUITE D ROOM 3
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-6166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-341-9993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2007