Provider First Line Business Practice Location Address:
2100 METROPOLITAN AVE
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66106-3061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-281-2541
Provider Business Practice Location Address Fax Number:
913-281-0994
Provider Enumeration Date:
02/17/2007