Provider First Line Business Practice Location Address:
FORT OSAGE R-I
Provider Second Line Business Practice Location Address:
2101 N TWYMAN ROAD
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64058-3200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-796-8762
Provider Business Practice Location Address Fax Number:
816-796-3657
Provider Enumeration Date:
10/24/2006