Provider First Line Business Practice Location Address: 
2340 E MEYER BLVD, BLDG 2
    Provider Second Line Business Practice Location Address: 
SUITE
    Provider Business Practice Location Address City Name: 
KANSAS CITY
    Provider Business Practice Location Address State Name: 
MO
    Provider Business Practice Location Address Postal Code: 
64132
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
816-276-1700
    Provider Business Practice Location Address Fax Number: 
816-276-1703
    Provider Enumeration Date: 
08/21/2009