Provider First Line Business Practice Location Address:
4609 INDEPENDENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64124-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-231-2222
Provider Business Practice Location Address Fax Number:
816-241-4214
Provider Enumeration Date:
08/26/2011