Provider First Line Business Practice Location Address:
801 W 57TH TER
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:
64113-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-0224
Provider Business Practice Location Address Fax Number:
816-333-0224
Provider Enumeration Date:
03/22/2007