Provider First Line Business Practice Location Address:
453 E. 111TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-2800
Provider Business Practice Location Address Fax Number:
800-765-5943
Provider Enumeration Date:
03/20/2007