Provider First Line Business Practice Location Address:
12110 HOLMES RD
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:
64145-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-3827
Provider Business Practice Location Address Fax Number:
816-942-3153
Provider Enumeration Date:
12/04/2008