Provider First Line Business Practice Location Address:
512 S 70TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66111-2433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-334-1650
Provider Business Practice Location Address Fax Number:
913-334-1873
Provider Enumeration Date:
07/16/2010