Provider First Line Business Practice Location Address:
801 W 47TH STREET
Provider Second Line Business Practice Location Address:
STE 408
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-561-6150
Provider Business Practice Location Address Fax Number:
816-561-6738
Provider Enumeration Date:
10/04/2006