Provider First Line Business Practice Location Address: 
11001 HAUSER ST.
    Provider Second Line Business Practice Location Address: 
SUITE A
    Provider Business Practice Location Address City Name: 
LENEXA
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66210
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
913-322-4100
    Provider Business Practice Location Address Fax Number: 
913-273-6398
    Provider Enumeration Date: 
03/22/2011