Provider First Line Business Practice Location Address:
10016 NW AMBASSADOR DT
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:
64153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-891-7162
Provider Business Practice Location Address Fax Number:
816-891-6704
Provider Enumeration Date:
03/02/2006