Provider First Line Business Practice Location Address:
325 EAST 135TH 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:
64145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-941-7788
Provider Business Practice Location Address Fax Number:
816-941-4413
Provider Enumeration Date:
09/20/2006