Provider First Line Business Practice Location Address:
201 E 99TH 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:
64114-4152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-474-3026
Provider Business Practice Location Address Fax Number:
816-474-3026
Provider Enumeration Date:
07/24/2007