Provider First Line Business Practice Location Address:
1215 E TRUMAN RD
Provider Second Line Business Practice Location Address:
ROOM:349
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64106-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-418-5204
Provider Business Practice Location Address Fax Number:
816-418-5230
Provider Enumeration Date:
09/01/2010