Provider First Line Business Practice Location Address:
904 E 68TH ST
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:
64131-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-333-5485
Provider Business Practice Location Address Fax Number:
816-361-4814
Provider Enumeration Date:
07/22/2005