Provider First Line Business Practice Location Address:
400 E RED BRIDGE RD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-4029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-8666
Provider Business Practice Location Address Fax Number:
816-942-8669
Provider Enumeration Date:
05/24/2005