Provider First Line Business Practice Location Address:
6336 N LUCERNE AVE
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:
64151-3199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-587-1827
Provider Business Practice Location Address Fax Number:
816-587-0830
Provider Enumeration Date:
11/22/2006