Provider First Line Business Practice Location Address:
1638 N CORRINGTON AVE
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:
64120-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-271-5989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2015