Provider First Line Business Practice Location Address:
5346 NW 64TH 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:
64151-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-587-0440
Provider Business Practice Location Address Fax Number:
816-587-3549
Provider Enumeration Date:
05/02/2007