Provider First Line Business Practice Location Address:
1534 CAMPBELL 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:
64108-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-842-1805
Provider Business Practice Location Address Fax Number:
816-214-9579
Provider Enumeration Date:
04/29/2009