Provider First Line Business Practice Location Address:
5140 NE ANTIOCH RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64119-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-221-2663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2006