Provider First Line Business Practice Location Address: 
751 E 63RD ST
    Provider Second Line Business Practice Location Address: 
SUITE 230
    Provider Business Practice Location Address City Name: 
KANSAS CITY
    Provider Business Practice Location Address State Name: 
MO
    Provider Business Practice Location Address Postal Code: 
64110-3385
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
816-333-2040
    Provider Business Practice Location Address Fax Number: 
816-333-1039
    Provider Enumeration Date: 
02/09/2007