Provider First Line Business Practice Location Address:
222 WEST GREGORY BLVD
Provider Second Line Business Practice Location Address:
SUITE 219
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
819-333-4490
Provider Business Practice Location Address Fax Number:
816-333-4490
Provider Enumeration Date:
12/06/2006