Provider First Line Business Practice Location Address:
2038 N 41ST 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:
66104-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-287-8304
Provider Business Practice Location Address Fax Number:
800-441-6055
Provider Enumeration Date:
01/23/2007