Provider First Line Business Practice Location Address:
4235 LOCUST 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:
64110-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-799-0123
Provider Business Practice Location Address Fax Number:
816-931-0282
Provider Enumeration Date:
02/14/2007