Provider First Line Business Practice Location Address:
5830 NW BARRY RD
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:
64154-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-880-6444
Provider Business Practice Location Address Fax Number:
816-880-6740
Provider Enumeration Date:
09/25/2006