Provider First Line Business Practice Location Address:
920 SHAWNEE RD
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:
66103-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-371-8226
Provider Business Practice Location Address Fax Number:
913-371-8226
Provider Enumeration Date:
10/13/2008