Provider First Line Business Practice Location Address:
4001 BLUE PKWY STE 101
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:
64130-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-474-1814
Provider Business Practice Location Address Fax Number:
816-474-1861
Provider Enumeration Date:
10/23/2007