Provider First Line Business Practice Location Address:
701 N 7TH ST RM 346
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:
66101-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-573-5507
Provider Business Practice Location Address Fax Number:
913-573-5511
Provider Enumeration Date:
01/26/2007