Provider First Line Business Practice Location Address:
12209 E 55TH ST
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:
64133-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-359-1581
Provider Business Practice Location Address Fax Number:
816-255-3408
Provider Enumeration Date:
12/09/2009