Provider First Line Business Practice Location Address:
1112 BROADWAY
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:
64105-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-221-4377
Provider Business Practice Location Address Fax Number:
816-221-0065
Provider Enumeration Date:
01/02/2007