Provider First Line Business Practice Location Address:
815 E 89TH 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:
64131-2753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-0746
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007