Provider First Line Business Practice Location Address:
506 NE 107TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64155-1574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-605-0034
Provider Business Practice Location Address Fax Number:
816-399-5090
Provider Enumeration Date:
06/11/2007