Provider First Line Business Practice Location Address:
6420 PROSPECT AVE
Provider Second Line Business Practice Location Address:
STE T403
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-1222
Provider Business Practice Location Address Fax Number:
816-363-0434
Provider Enumeration Date:
10/05/2006