Provider First Line Business Practice Location Address:
5501 NW 62ND TER
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64151-2411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-584-8884
Provider Business Practice Location Address Fax Number:
913-588-9220
Provider Enumeration Date:
08/30/2006