Provider First Line Business Practice Location Address:
7704 STATE AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-334-4151
Provider Business Practice Location Address Fax Number:
913-334-0303
Provider Enumeration Date:
10/03/2006