Provider First Line Business Practice Location Address:
3736 LOCUST ST
Provider Second Line Business Practice Location Address:
APARTMENT 32
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64109-2283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-375-6166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2016