Provider First Line Business Practice Location Address:
4837 STATE AVE
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:
66102-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-287-2828
Provider Business Practice Location Address Fax Number:
913-287-8079
Provider Enumeration Date:
08/02/2005