Provider First Line Business Practice Location Address:
1600 GENESSEE ST STE 346
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:
64102-1090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-842-2882
Provider Business Practice Location Address Fax Number:
816-880-0023
Provider Enumeration Date:
06/20/2007