Provider First Line Business Practice Location Address:
4400 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-3498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-932-1711
Provider Business Practice Location Address Fax Number:
816-932-1719
Provider Enumeration Date:
08/31/2006