Provider First Line Business Practice Location Address:
4400 E 39TH 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:
64128-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-791-7177
Provider Business Practice Location Address Fax Number:
816-791-7190
Provider Enumeration Date:
10/10/2024