Provider First Line Business Practice Location Address:
2536 INDEPENDENCE AVE
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:
64124-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-819-4704
Provider Business Practice Location Address Fax Number:
816-231-5229
Provider Enumeration Date:
05/06/2026