Provider First Line Business Practice Location Address:
1511 NE PARVIN RD
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:
64116-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-452-6194
Provider Business Practice Location Address Fax Number:
816-454-3211
Provider Enumeration Date:
12/18/2006