Provider First Line Business Practice Location Address:
2204 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64079-7628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-858-3838
Provider Business Practice Location Address Fax Number:
816-858-5389
Provider Enumeration Date:
09/20/2006