Provider First Line Business Practice Location Address:
6724 TROOST AVE
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-1414
Provider Business Practice Location Address Fax Number:
816-523-2123
Provider Enumeration Date:
03/21/2007