Provider First Line Business Practice Location Address:
6420 PROSPECT AVE STE T103
Provider Second Line Business Practice Location Address:
T103
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64132-4175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-363-3232
Provider Business Practice Location Address Fax Number:
816-361-6402
Provider Enumeration Date:
07/30/2006