Provider First Line Business Practice Location Address:
307 E US HIGHWAY 69
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:
64119-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-455-3119
Provider Business Practice Location Address Fax Number:
816-453-0381
Provider Enumeration Date:
07/10/2006