Provider First Line Business Practice Location Address:
400 E RED BRIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-7730
Provider Business Practice Location Address Fax Number:
816-942-7738
Provider Enumeration Date:
10/27/2006