Provider First Line Business Practice Location Address:
8002 N BRIGHTON AVE
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:
64119-1474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-436-2208
Provider Business Practice Location Address Fax Number:
816-436-2209
Provider Enumeration Date:
09/18/2009