Provider First Line Business Practice Location Address:
4203 BOOTH ST
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:
66103-3116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-948-0688
Provider Business Practice Location Address Fax Number:
913-261-9634
Provider Enumeration Date:
07/16/2007