Provider First Line Business Practice Location Address:
816 HUNTINGTON 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:
64113-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-361-1562
Provider Business Practice Location Address Fax Number:
241-712-2487
Provider Enumeration Date:
04/26/2010