Provider First Line Business Practice Location Address:
2713 E 31ST ST
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:
64128-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-924-6533
Provider Business Practice Location Address Fax Number:
816-924-0698
Provider Enumeration Date:
06/28/2006