Provider First Line Business Practice Location Address:
11118 COLLEGE AVE
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:
64137-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-564-2466
Provider Business Practice Location Address Fax Number:
816-965-7420
Provider Enumeration Date:
03/07/2008