Provider First Line Business Practice Location Address:
4320 WORNALL RD
Provider Second Line Business Practice Location Address:
MEDICAL PLAZA I, SUITE 336
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-5941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-932-6100
Provider Business Practice Location Address Fax Number:
816-932-1786
Provider Enumeration Date:
05/17/2010