Provider First Line Business Practice Location Address:
5643 LOCUST 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:
64110-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-383-4596
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2015