Provider First Line Business Practice Location Address:
21 N 12TH ST STE 350
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:
66102-5172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-371-1667
Provider Business Practice Location Address Fax Number:
913-371-2798
Provider Enumeration Date:
08/14/2008