Provider First Line Business Practice Location Address:
2406 S 24TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66106-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-558-3262
Provider Business Practice Location Address Fax Number:
913-558-3262
Provider Enumeration Date:
06/30/2026