Provider First Line Business Practice Location Address:
720 CENTRAL AVE
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:
66101-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-321-3343
Provider Business Practice Location Address Fax Number:
913-321-3348
Provider Enumeration Date:
07/02/2007