Provider First Line Business Practice Location Address:
1731 NORTH 90TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-1689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-732-5900
Provider Business Practice Location Address Fax Number:
913-541-5830
Provider Enumeration Date:
07/22/2005