Provider First Line Business Practice Location Address:
636 MINNESOTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66101-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-371-9966
Provider Business Practice Location Address Fax Number:
913-371-1936
Provider Enumeration Date:
05/18/2006