Provider First Line Business Practice Location Address:
1428 S 32ND ST UPPR LEVEL
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:
66106-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-384-1630
Provider Business Practice Location Address Fax Number:
913-384-6531
Provider Enumeration Date:
09/20/2006