Provider First Line Business Practice Location Address:
5884 NE RUSSELL RD
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:
64117-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-781-4332
Provider Business Practice Location Address Fax Number:
816-781-8820
Provider Enumeration Date:
03/21/2007