Provider First Line Business Practice Location Address:
10918 ELM AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KS KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-767-7608
Provider Business Practice Location Address Fax Number:
816-251-6367
Provider Enumeration Date:
12/14/2006