Provider First Line Business Practice Location Address:
7161 STATE AVE
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:
66112-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-3548
Provider Business Practice Location Address Fax Number:
913-299-9830
Provider Enumeration Date:
12/03/2007