Provider First Line Business Practice Location Address:
4330 WASHINGTON ST
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:
64111-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-561-1422
Provider Business Practice Location Address Fax Number:
816-777-0626
Provider Enumeration Date:
03/27/2020