Provider First Line Business Practice Location Address:
6708 STATE AVE
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:
66102-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-8554
Provider Business Practice Location Address Fax Number:
913-299-3187
Provider Enumeration Date:
12/26/2005