Provider First Line Business Practice Location Address:
8524 N CAMPBELL STREET
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:
64155-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-734-5222
Provider Business Practice Location Address Fax Number:
816-420-0084
Provider Enumeration Date:
09/17/2010