Provider First Line Business Practice Location Address:
300 E 36TH 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:
64111-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-508-3569
Provider Business Practice Location Address Fax Number:
816-508-3535
Provider Enumeration Date:
02/01/2017