Provider First Line Business Practice Location Address:
3100 BROADWAY ST STE 218
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:
64111-2448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-753-2007
Provider Business Practice Location Address Fax Number:
816-753-5551
Provider Enumeration Date:
01/25/2011