Provider First Line Business Practice Location Address:
9119 W. 74TH STREET, SUITE 354
Provider Second Line Business Practice Location Address:
SHAWNEE MISSION MEDICAL BUILDING
Provider Business Practice Location Address City Name:
MERRIAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-894-2121
Provider Business Practice Location Address Fax Number:
913-894-9592
Provider Enumeration Date:
07/30/2006