Provider First Line Business Practice Location Address:
1607 N 46TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-330-9488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2026