Provider First Line Business Practice Location Address:
300 W 19TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-404-5709
Provider Business Practice Location Address Fax Number:
816-404-6024
Provider Enumeration Date:
12/06/2006