Provider First Line Business Practice Location Address:
6326 N SPRUCE AVE
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:
64119-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-459-7873
Provider Business Practice Location Address Fax Number:
816-459-7873
Provider Enumeration Date:
02/11/2008