Provider First Line Business Practice Location Address:
8437 STATE AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-0276
Provider Business Practice Location Address Fax Number:
913-299-3775
Provider Enumeration Date:
07/30/2006