Provider First Line Business Practice Location Address:
6013 LEAVENWORTH RD
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:
66104-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-4755
Provider Business Practice Location Address Fax Number:
816-942-1581
Provider Enumeration Date:
11/24/2008