Provider First Line Business Practice Location Address:
1803 E 128TH ST
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:
64145-7811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-944-0777
Provider Business Practice Location Address Fax Number:
816-875-4035
Provider Enumeration Date:
05/20/2026