Provider First Line Business Practice Location Address:
6420 PROSPECT AVENUE
Provider Second Line Business Practice Location Address:
SUITE T101
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132-1186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-363-4100
Provider Business Practice Location Address Fax Number:
816-363-8201
Provider Enumeration Date:
10/31/2005