Provider First Line Business Practice Location Address:
100 W 9TH 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:
64105-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-232-2745
Provider Business Practice Location Address Fax Number:
816-326-9027
Provider Enumeration Date:
07/12/2025