Provider First Line Business Practice Location Address:
1133 COLLEGE AVE BLDG B
Provider Second Line Business Practice Location Address:
#224
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-2770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-537-9349
Provider Business Practice Location Address Fax Number:
785-537-9486
Provider Enumeration Date:
09/06/2006