Provider First Line Business Practice Location Address:
517 CAMPBELL 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:
64106-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-699-2928
Provider Business Practice Location Address Fax Number:
816-466-5969
Provider Enumeration Date:
03/29/2010