Provider First Line Business Practice Location Address:
4910A NE 81ST 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:
64119-8400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-420-9070
Provider Business Practice Location Address Fax Number:
816-420-9052
Provider Enumeration Date:
12/27/2005