Provider First Line Business Practice Location Address:
6028 TROOST 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:
64110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-444-9191
Provider Business Practice Location Address Fax Number:
816-363-0878
Provider Enumeration Date:
03/14/2007