Provider First Line Business Practice Location Address:
600 W 39TH 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:
64111-2910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-421-7608
Provider Business Practice Location Address Fax Number:
816-421-6493
Provider Enumeration Date:
10/12/2018