Provider First Line Business Practice Location Address:
1 E 34TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-1271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-960-4992
Provider Business Practice Location Address Fax Number:
816-960-3821
Provider Enumeration Date:
04/23/2007