Provider First Line Business Practice Location Address:
3215 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-2645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-931-3215
Provider Business Practice Location Address Fax Number:
816-931-3217
Provider Enumeration Date:
04/19/2007