Provider First Line Business Practice Location Address:
1301 NORTH 41ST STREET
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:
66102-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-868-7996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2007