Provider First Line Business Practice Location Address:
6908 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:
64153-1764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-665-8838
Provider Business Practice Location Address Fax Number:
816-584-0149
Provider Enumeration Date:
10/19/2006