Provider First Line Business Practice Location Address:
6420 PROSPECT AVE
Provider Second Line Business Practice Location Address:
SUITE T303
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132-4147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-1919
Provider Business Practice Location Address Fax Number:
816-333-2614
Provider Enumeration Date:
07/12/2007