Provider First Line Business Practice Location Address:
5604 TROOST AVE
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:
64110-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-444-1720
Provider Business Practice Location Address Fax Number:
816-444-1721
Provider Enumeration Date:
01/28/2016