Provider First Line Business Practice Location Address:
5517 NW 81ST 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:
64151-1257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-686-1870
Provider Business Practice Location Address Fax Number:
816-741-4387
Provider Enumeration Date:
03/31/2008