Provider First Line Business Practice Location Address:
1701 S 45TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66106-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-281-5121
Provider Business Practice Location Address Fax Number:
913-371-6811
Provider Enumeration Date:
08/30/2006