Provider First Line Business Practice Location Address:
220 W 75TH STREET
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:
64114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-8421
Provider Business Practice Location Address Fax Number:
816-523-0909
Provider Enumeration Date:
11/13/2006