Provider First Line Business Practice Location Address:
4301 STATE AVE BLDG A
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:
66102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-287-7977
Provider Business Practice Location Address Fax Number:
913-273-2502
Provider Enumeration Date:
10/20/2015