Provider First Line Business Practice Location Address:
8150 N FARLEY AVE
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:
64158-7621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-204-6177
Provider Business Practice Location Address Fax Number:
816-736-5605
Provider Enumeration Date:
12/11/2008