Provider First Line Business Practice Location Address:
721 N 31ST ST
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:
66102-3962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-621-0074
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2025