Provider First Line Business Practice Location Address:
4230 S PHELPS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64055-5067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-478-9031
Provider Business Practice Location Address Fax Number:
816-350-3406
Provider Enumeration Date:
03/27/2007