Provider First Line Business Practice Location Address:
808 W 99TH 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:
64114-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-974-0282
Provider Business Practice Location Address Fax Number:
816-817-1147
Provider Enumeration Date:
08/07/2008