Provider First Line Business Practice Location Address:
400 E RED BRIDGE ROAD
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-4030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-4330
Provider Business Practice Location Address Fax Number:
816-942-4331
Provider Enumeration Date:
05/21/2007