Provider First Line Business Practice Location Address:
151 S 18TH ST
Provider Second Line Business Practice Location Address:
SUITE Q
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66102-5635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-333-5085
Provider Business Practice Location Address Fax Number:
913-333-5084
Provider Enumeration Date:
06/27/2016