Provider First Line Business Practice Location Address:
1819 WYANDOTTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64108-1980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-841-0206
Provider Business Practice Location Address Fax Number:
816-221-5503
Provider Enumeration Date:
02/16/2016