Provider First Line Business Practice Location Address:
2905 CAMPBELL ST
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:
64109-1417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-531-6168
Provider Business Practice Location Address Fax Number:
816-931-7380
Provider Enumeration Date:
02/19/2008