Provider First Line Business Practice Location Address:
930 CARONDELET DR
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-222-2229
Provider Business Practice Location Address Fax Number:
816-943-1904
Provider Enumeration Date:
05/23/2005