Provider First Line Business Practice Location Address:
1150 W. 75TH STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-831-2979
Provider Business Practice Location Address Fax Number:
913-831-9566
Provider Enumeration Date:
07/21/2006