Provider First Line Business Practice Location Address:
1115 EAST 65TH 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:
64131-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-523-7766
Provider Business Practice Location Address Fax Number:
816-523-2263
Provider Enumeration Date:
02/26/2007