Provider First Line Business Practice Location Address:
211 NE 54TH 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:
64118-4362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-455-2020
Provider Business Practice Location Address Fax Number:
816-459-5690
Provider Enumeration Date:
06/26/2006