Provider First Line Business Practice Location Address:
1211 MCGEE ST
Provider Second Line Business Practice Location Address:
ROOM 905-C
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64106-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-418-7840
Provider Business Practice Location Address Fax Number:
816-418-1805
Provider Enumeration Date:
12/15/2006