Provider First Line Business Practice Location Address:
1125 GRAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 1313
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-842-8180
Provider Business Practice Location Address Fax Number:
816-842-8180
Provider Enumeration Date:
08/02/2006