Provider First Line Business Practice Location Address:
707 W 47TH ST
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:
64112-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-561-4466
Provider Business Practice Location Address Fax Number:
816-753-2221
Provider Enumeration Date:
05/30/2007