Provider First Line Business Practice Location Address:
10015 N AMBASSADOR DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64153-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-448-8929
Provider Business Practice Location Address Fax Number:
816-448-8928
Provider Enumeration Date:
03/06/2014