Provider First Line Business Practice Location Address:
250 NE MULBERRY ST
Provider Second Line Business Practice Location Address:
SJS MEDICAL MANAGEMENT, SUITE 202
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64086-4533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-389-4130
Provider Business Practice Location Address Fax Number:
816-389-4140
Provider Enumeration Date:
09/24/2006