Provider First Line Business Practice Location Address:
310 S PLATTE CLAY WAY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64060-8797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-914-5322
Provider Business Practice Location Address Fax Number:
816-628-5452
Provider Enumeration Date:
12/20/2007