Provider First Line Business Practice Location Address:
6311 N BALES 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:
64119-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-980-3937
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2025