Provider First Line Business Practice Location Address:
406 W 34TH ST
Provider Second Line Business Practice Location Address:
SUITE 812
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-931-2293
Provider Business Practice Location Address Fax Number:
816-931-5307
Provider Enumeration Date:
07/23/2007