Provider First Line Business Practice Location Address:
10090 NW PRAIRIE VIEW RD
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:
64153-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-789-4075
Provider Business Practice Location Address Fax Number:
913-888-1728
Provider Enumeration Date:
03/26/2010