Provider First Line Business Practice Location Address:
444 W 47TH STREET
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112-1952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-561-9666
Provider Business Practice Location Address Fax Number:
816-561-8304
Provider Enumeration Date:
10/04/2006