Provider First Line Business Practice Location Address: 
3901 RAINBOW BLVD
    Provider Second Line Business Practice Location Address: 
DEPT OF PSYCHIATRY
    Provider Business Practice Location Address City Name: 
KANSAS CITY
    Provider Business Practice Location Address State Name: 
KS
    Provider Business Practice Location Address Postal Code: 
66160-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
913-588-6400
    Provider Business Practice Location Address Fax Number: 
913-588-6414
    Provider Enumeration Date: 
12/01/2006