Provider First Line Business Practice Location Address:
1936 N 5TH ST
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:
66101-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-210-3931
Provider Business Practice Location Address Fax Number:
913-273-5946
Provider Enumeration Date:
09/18/2024