Provider First Line Business Practice Location Address:
6515 NE 44TH 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:
64117-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-405-2141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2010