Provider First Line Business Practice Location Address:
200 NE 54TH ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64118-4389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-799-0180
Provider Business Practice Location Address Fax Number:
630-528-9579
Provider Enumeration Date:
08/12/2006