Provider First Line Business Practice Location Address:
3220 E 23RD 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:
64127-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-842-5836
Provider Business Practice Location Address Fax Number:
816-421-5026
Provider Enumeration Date:
04/21/2014