Provider First Line Business Practice Location Address:
114 E 41ST ST
Provider Second Line Business Practice Location Address:
APT 3
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64111-4927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-329-4844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2017