Provider First Line Business Practice Location Address:
1148 W. 103RD 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:
64114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-4300
Provider Business Practice Location Address Fax Number:
816-942-4302
Provider Enumeration Date:
11/01/2010