Provider First Line Business Practice Location Address:
11338 W 63RD ST
Provider Second Line Business Practice Location Address:
UPPER NORTHERN SUITE
Provider Business Practice Location Address City Name:
SHAWNEE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66203-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-248-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2008