Provider First Line Business Practice Location Address:
1416 NE PARVIN RD APT 303
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:
64116-5043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-532-7516
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2026