Provider First Line Business Practice Location Address:
1312 W 6TH ST
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:
66044-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-841-7297
Provider Business Practice Location Address Fax Number:
785-856-0375
Provider Enumeration Date:
07/10/2023