Provider First Line Business Practice Location Address:
6400 NE 52ND 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:
64119-3243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-321-5140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2021