Provider First Line Business Practice Location Address:
2029 BURLINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-221-3255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2005