Provider First Line Business Practice Location Address:
151 S 18TH ST STE Q
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:
66102-5625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-901-9865
Provider Business Practice Location Address Fax Number:
816-503-9404
Provider Enumeration Date:
03/21/2013