Provider First Line Business Practice Location Address:
101 E 63RD STREET
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:
64113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-1393
Provider Business Practice Location Address Fax Number:
816-361-6275
Provider Enumeration Date:
10/25/2006