Provider First Line Business Practice Location Address:
10127 LEAVENWORTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66109-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-894-1143
Provider Business Practice Location Address Fax Number:
913-894-4055
Provider Enumeration Date:
12/05/2006