Provider First Line Business Practice Location Address:
5619 CHARLOTTE ST
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:
64110-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-452-6200
Provider Business Practice Location Address Fax Number:
816-452-6202
Provider Enumeration Date:
12/13/2006