Provider First Line Business Practice Location Address:
1744 BROADWAY, SUITE B
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:
64108-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-221-5225
Provider Business Practice Location Address Fax Number:
816-221-5220
Provider Enumeration Date:
10/12/2006