Provider First Line Business Practice Location Address:
800 E 101ST TER
Provider Second Line Business Practice Location Address:
STE 350
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-226-6605
Provider Business Practice Location Address Fax Number:
816-877-9137
Provider Enumeration Date:
02/29/2012