Provider First Line Business Practice Location Address:
3101 BROADWAY
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:
64111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-960-8040
Provider Business Practice Location Address Fax Number:
816-960-3084
Provider Enumeration Date:
09/03/2008