Provider First Line Business Practice Location Address:
C/O CENTERPOINT MEDICAL CENTER
Provider Second Line Business Practice Location Address:
19550 E 39TH ST, STE 110
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64057-2353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-698-8900
Provider Business Practice Location Address Fax Number:
816-698-8905
Provider Enumeration Date:
11/19/2012