Provider First Line Business Practice Location Address:
2933 S 47TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-677-1004
Provider Business Practice Location Address Fax Number:
913-677-2820
Provider Enumeration Date:
10/04/2006