Provider First Line Business Practice Location Address:
2530 W 47TH AVE APT 2
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:
66103-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-789-7876
Provider Business Practice Location Address Fax Number:
913-677-2184
Provider Enumeration Date:
11/25/2008