Provider First Line Business Practice Location Address:
10500 LACKMAN RD
Provider Second Line Business Practice Location Address:
JC PENNEY MEDICAL OFFICE
Provider Business Practice Location Address City Name:
LENEXA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-541-2365
Provider Business Practice Location Address Fax Number:
913-541-3108
Provider Enumeration Date:
12/24/2009