Provider First Line Business Practice Location Address:
930 CARONDELET DR
Provider Second Line Business Practice Location Address:
ST JOSEPH MEDICAL BLDG STE 300
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-642-1112
Provider Business Practice Location Address Fax Number:
913-648-7876
Provider Enumeration Date:
09/06/2006