Provider First Line Business Practice Location Address:
1216 N 77TH ST
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:
66112-2408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-835-5580
Provider Business Practice Location Address Fax Number:
816-561-7412
Provider Enumeration Date:
03/17/2010