Provider First Line Business Practice Location Address:
1150 N 38TH 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:
66102-2227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-300-0452
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2021