Provider First Line Business Practice Location Address:
9223 NE 152 HIGHWAY
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:
64158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-792-2266
Provider Business Practice Location Address Fax Number:
816-792-3526
Provider Enumeration Date:
07/30/2020