Provider First Line Business Practice Location Address:
5415 NE ANTIOCH RD
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:
64119-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-414-2768
Provider Business Practice Location Address Fax Number:
816-454-0070
Provider Enumeration Date:
12/19/2006