Provider First Line Business Practice Location Address:
701 E. 63RD
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:
64110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-501-0168
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2007