Provider First Line Business Practice Location Address:
3530 LOCUST ST
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:
64109-2263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-985-4068
Provider Business Practice Location Address Fax Number:
816-561-2407
Provider Enumeration Date:
02/13/2008