Provider First Line Business Practice Location Address:
2060 W 39TH AVENUE
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:
66103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-916-1601
Provider Business Practice Location Address Fax Number:
913-588-5000
Provider Enumeration Date:
07/19/2020