Provider First Line Business Practice Location Address:
2103 N 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-924-9683
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2018