Provider First Line Business Practice Location Address:
3234 N 36TH 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:
66104-3714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-371-0477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2007