Provider First Line Business Practice Location Address:
6400 E 23RD 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:
64129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-231-5746
Provider Business Practice Location Address Fax Number:
816-889-1849
Provider Enumeration Date:
09/24/2010