Provider First Line Business Practice Location Address:
6301 N LUCERNE AVE
Provider Second Line Business Practice Location Address:
MOSAIC LIFE CARE AT BURLINGTON CREEK
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64151-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-387-7673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2006