Provider First Line Business Practice Location Address:
3147 S 49TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66106-3782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-394-8997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2024