Provider First Line Business Practice Location Address:
7610 E 49TH ST
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:
64129-2043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-560-3828
Provider Business Practice Location Address Fax Number:
816-921-4995
Provider Enumeration Date:
11/27/2007