Provider First Line Business Practice Location Address:
721 N 31ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102-3964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-621-0074
Provider Business Practice Location Address Fax Number:
913-621-1996
Provider Enumeration Date:
06/14/2012