Provider First Line Business Practice Location Address:
1447 INDEPENDENCE AVE STE 144
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:
64106-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-433-9003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2026