Provider First Line Business Practice Location Address:
4427 HARRISON 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:
64110-1627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-589-8908
Provider Business Practice Location Address Fax Number:
816-531-4071
Provider Enumeration Date:
06/12/2006