Provider First Line Business Practice Location Address:
3002 NE 37TH 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:
64117-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-205-6601
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2026