Provider First Line Business Practice Location Address:
1216 CENTRAL AVE
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:
66102-5410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-281-4778
Provider Business Practice Location Address Fax Number:
913-281-2703
Provider Enumeration Date:
09/01/2005