Provider First Line Business Practice Location Address:
2464 CHARLOTTE 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:
64108-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-235-2195
Provider Business Practice Location Address Fax Number:
816-325-6008
Provider Enumeration Date:
06/15/2009