Provider First Line Business Practice Location Address: 
KANSAS UNIVERSITY MED CTR
    Provider Second Line Business Practice Location Address: 
3901 RAINBOW BLVD, MS 1034
    Provider Business Practice Location Address City Name: 
KANSAS CITY
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66160-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
913-588-3304
    Provider Business Practice Location Address Fax Number: 
913-588-3365
    Provider Enumeration Date: 
06/06/2011