Provider First Line Business Practice Location Address:
3005 N 31ST 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:
66104-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-674-5181
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2026