Provider First Line Business Practice Location Address:
1734 E 63RD ST
Provider Second Line Business Practice Location Address:
STE. 214
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64110-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-822-9000
Provider Business Practice Location Address Fax Number:
816-822-9002
Provider Enumeration Date:
01/29/2011