Provider First Line Business Practice Location Address:
819 E 93RD 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:
64131-2997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-841-9666
Provider Business Practice Location Address Fax Number:
816-399-4963
Provider Enumeration Date:
08/02/2009