Provider First Line Business Practice Location Address:
406 W 34TH ST
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-753-5171
Provider Business Practice Location Address Fax Number:
816-931-8189
Provider Enumeration Date:
11/17/2006