Provider First Line Business Practice Location Address:
3101 BROADWAY BLVD
Provider Second Line Business Practice Location Address:
DERMATOLOGY DIVISION
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-960-4100
Provider Business Practice Location Address Fax Number:
816-960-4053
Provider Enumeration Date:
06/06/2011