Provider First Line Business Practice Location Address:
4019 N 111TH ST
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:
66109-3576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-721-9929
Provider Business Practice Location Address Fax Number:
913-721-1527
Provider Enumeration Date:
03/01/2007