Provider First Line Business Practice Location Address:
5775 NW 64TH TERRACE
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-391-9008
Provider Business Practice Location Address Fax Number:
816-746-4753
Provider Enumeration Date:
08/04/2006