Provider First Line Business Practice Location Address:
1401 N 18TH 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:
66102-2845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-387-4773
Provider Business Practice Location Address Fax Number:
913-621-2297
Provider Enumeration Date:
01/09/2010