Provider First Line Business Practice Location Address: 
6815 FRONTAGE RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SHAWNEE MISSION
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66204-1398
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
816-478-4200
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/27/2014