Provider First Line Business Practice Location Address:
2608 E 73RD 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:
64132-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-779-1442
Provider Business Practice Location Address Fax Number:
816-361-6737
Provider Enumeration Date:
06/27/2007