Provider First Line Business Practice Location Address:
5036 PROSPECT 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:
64130-2651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-506-6505
Provider Business Practice Location Address Fax Number:
816-236-7957
Provider Enumeration Date:
12/14/2007