Provider First Line Business Practice Location Address:
3134 STATE AVE
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:
66102-3920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-233-2600
Provider Business Practice Location Address Fax Number:
913-371-0504
Provider Enumeration Date:
10/15/2008