Provider First Line Business Practice Location Address:
127 W 10TH ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64105-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-404-0787
Provider Business Practice Location Address Fax Number:
816-404-0701
Provider Enumeration Date:
06/29/2006