Provider First Line Business Practice Location Address:
2845 N 39TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66104-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-219-8796
Provider Business Practice Location Address Fax Number:
816-734-1485
Provider Enumeration Date:
04/27/2012