Provider First Line Business Practice Location Address:
8908 E. 89TH 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:
64138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-876-9213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2007