Provider First Line Business Practice Location Address:
3145 BROADWAY 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:
64111-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-223-6740
Provider Business Practice Location Address Fax Number:
816-561-3939
Provider Enumeration Date:
05/07/2007