Provider First Line Business Practice Location Address:
1152 COUNTY LINE RD APT 32
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66103-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-830-4514
Provider Business Practice Location Address Fax Number:
816-241-2797
Provider Enumeration Date:
02/05/2007