Provider First Line Business Practice Location Address:
506 E 122ND 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:
64145-1778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-941-2849
Provider Business Practice Location Address Fax Number:
816-941-2849
Provider Enumeration Date:
11/14/2013