Provider First Line Business Practice Location Address:
5019 LEAVENWORTH RD
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:
66104-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-789-9573
Provider Business Practice Location Address Fax Number:
913-789-9268
Provider Enumeration Date:
09/20/2006