Provider First Line Business Practice Location Address:
400 E RED BRIDGE RD
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-1811
Provider Business Practice Location Address Fax Number:
816-941-0419
Provider Enumeration Date:
03/05/2008