Provider First Line Business Practice Location Address:
8316 PROSPECT AVE
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:
64132-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-726-3670
Provider Business Practice Location Address Fax Number:
816-298-6907
Provider Enumeration Date:
09/11/2009