Provider First Line Business Practice Location Address:
1999 N 77TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-788-9896
Provider Business Practice Location Address Fax Number:
913-788-7080
Provider Enumeration Date:
04/19/2006