Provider First Line Business Practice Location Address:
9501 NORTH OAK
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-436-2242
Provider Business Practice Location Address Fax Number:
816-436-5435
Provider Enumeration Date:
09/20/2006