Provider First Line Business Practice Location Address:
10002 NW AMBASSADOR DR
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:
64153-1586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
861-891-8091
Provider Business Practice Location Address Fax Number:
816-891-9343
Provider Enumeration Date:
10/04/2005