Provider First Line Business Practice Location Address:
706 W 42ND 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:
64111-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-931-0177
Provider Business Practice Location Address Fax Number:
816-561-4592
Provider Enumeration Date:
09/28/2009