Provider First Line Business Practice Location Address:
2917 N 38TH ST
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:
66104-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-499-1097
Provider Business Practice Location Address Fax Number:
913-499-1098
Provider Enumeration Date:
03/15/2023