Provider First Line Business Practice Location Address:
930 CARONDELET DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64114-4855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-941-2222
Provider Business Practice Location Address Fax Number:
816-941-2282
Provider Enumeration Date:
12/30/2005