Provider First Line Business Practice Location Address:
506 NE 107TH STREET
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
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:
816-817-1181
Provider Enumeration Date:
08/20/2013