Provider First Line Business Practice Location Address:
6324 NW BARRY RD
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:
64154-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-741-4525
Provider Business Practice Location Address Fax Number:
816-220-9099
Provider Enumeration Date:
11/05/2007