Provider First Line Business Practice Location Address:
10700 EAST 109TH 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:
64134-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-763-5130
Provider Business Practice Location Address Fax Number:
816-763-5302
Provider Enumeration Date:
05/30/2007