Provider First Line Business Practice Location Address:
6400 PROSPECT AVE STE 338
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:
64132-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-361-6070
Provider Business Practice Location Address Fax Number:
816-361-6105
Provider Enumeration Date:
10/13/2006