Provider First Line Business Practice Location Address:
415 NE 103RD ST
Provider Second Line Business Practice Location Address:
APT 5E
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64155-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-590-9120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2008