Provider First Line Business Practice Location Address:
6604 E 12TH ST
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:
64126-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-483-9927
Provider Business Practice Location Address Fax Number:
816-483-9934
Provider Enumeration Date:
08/18/2009