Provider First Line Business Practice Location Address:
115 E 83RD ST
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:
64114-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-3988
Provider Business Practice Location Address Fax Number:
816-444-9045
Provider Enumeration Date:
05/02/2007