Provider First Line Business Practice Location Address:
9501 STATE AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66111-1872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-7200
Provider Business Practice Location Address Fax Number:
913-334-4551
Provider Enumeration Date:
09/27/2005