Provider First Line Business Practice Location Address:
4410 PENNSYLVANIA AVE APT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-766-5412
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2009