Provider First Line Business Practice Location Address:
753 STATE AVE
Provider Second Line Business Practice Location Address:
STE 665
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66101-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-321-4385
Provider Business Practice Location Address Fax Number:
913-321-4037
Provider Enumeration Date:
09/26/2006