Provider First Line Business Practice Location Address:
9630 N BRADFORD 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:
64154-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-891-6559
Provider Business Practice Location Address Fax Number:
816-891-7481
Provider Enumeration Date:
12/15/2008