Provider First Line Business Practice Location Address:
4415 NE 80TH CT
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:
64119-4476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-616-4796
Provider Business Practice Location Address Fax Number:
816-841-1431
Provider Enumeration Date:
02/22/2007