Provider First Line Business Practice Location Address:
3228 N 109TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-263-6181
Provider Business Practice Location Address Fax Number:
517-263-6181
Provider Enumeration Date:
07/25/2006