Provider First Line Business Practice Location Address:
1734 E 63RD ST
Provider Second Line Business Practice Location Address:
STE 470
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64110-5341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-6555
Provider Business Practice Location Address Fax Number:
816-333-6564
Provider Enumeration Date:
06/25/2005