Provider First Line Business Practice Location Address:
3118 N 128TH 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:
66109-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-645-1141
Provider Business Practice Location Address Fax Number:
913-904-0168
Provider Enumeration Date:
03/04/2011