Provider First Line Business Practice Location Address:
5008 NE 45TH TER
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:
64117-1944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-452-1129
Provider Business Practice Location Address Fax Number:
816-452-5120
Provider Enumeration Date:
03/02/2007