Provider First Line Business Practice Location Address:
1235 W 64TH ST
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:
64113-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-444-6554
Provider Business Practice Location Address Fax Number:
816-822-7017
Provider Enumeration Date:
10/13/2010