Provider First Line Business Practice Location Address:
2998 SE 228TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHROP
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64465-9381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-349-5281
Provider Business Practice Location Address Fax Number:
816-349-5281
Provider Enumeration Date:
02/10/2026