Provider First Line Business Practice Location Address:
4154 NW BARRY RD
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:
64154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-225-5930
Provider Business Practice Location Address Fax Number:
913-671-7744
Provider Enumeration Date:
01/18/2006