Provider First Line Business Practice Location Address:
1211 N 8TH 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:
66101-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-575-0245
Provider Business Practice Location Address Fax Number:
913-499-0232
Provider Enumeration Date:
10/24/2016