Provider First Line Business Practice Location Address:
1911 E 23RD ST
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:
64127-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-531-7737
Provider Business Practice Location Address Fax Number:
816-833-8330
Provider Enumeration Date:
01/22/2015