Provider First Line Business Practice Location Address:
5501 NW 62ND TER STE 102
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:
64151-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-453-4485
Provider Business Practice Location Address Fax Number:
816-453-4101
Provider Enumeration Date:
10/26/2007