Provider First Line Business Practice Location Address:
2411 HOLMES ST
Provider Second Line Business Practice Location Address:
ROOM M3-C19
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64108-2741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-512-7475
Provider Business Practice Location Address Fax Number:
816-512-7478
Provider Enumeration Date:
07/07/2005