Provider First Line Business Practice Location Address:
335 NW BARRY RD
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:
64155-2740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
164-685-2788
Provider Business Practice Location Address Fax Number:
162-855-2788
Provider Enumeration Date:
07/22/2020