Provider First Line Business Practice Location Address:
2816 E 23RD 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:
64127-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-231-3955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2006