Provider First Line Business Practice Location Address:
5407 NW 83RD TER
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:
64151-1027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-746-9365
Provider Business Practice Location Address Fax Number:
432-225-2175
Provider Enumeration Date:
03/10/2011