Provider First Line Business Practice Location Address:
308 W 8TH ST
Provider Second Line Business Practice Location Address:
208
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64105-1579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-229-2557
Provider Business Practice Location Address Fax Number:
816-221-4946
Provider Enumeration Date:
07/12/2005