Provider First Line Business Practice Location Address:
1010 CARONDELET DR
Provider Second Line Business Practice Location Address:
SUITE 224A
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-4859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-943-0706
Provider Business Practice Location Address Fax Number:
816-943-6122
Provider Enumeration Date:
01/14/2007