Provider First Line Business Practice Location Address:
2000 NE 46 STREET
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:
64116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-413-5107
Provider Business Practice Location Address Fax Number:
816-413-5105
Provider Enumeration Date:
08/28/2012