Provider First Line Business Practice Location Address:
101 E 23RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-221-2153
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2006