Provider First Line Business Practice Location Address:
3700 WEST 83RD STREET
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-381-5292
Provider Business Practice Location Address Fax Number:
913-381-5293
Provider Enumeration Date:
07/26/2006