Provider First Line Business Practice Location Address:
912 E 63RD 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:
64110-3444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-2221
Provider Business Practice Location Address Fax Number:
816-523-2303
Provider Enumeration Date:
11/28/2006