Provider First Line Business Practice Location Address:
1422 N 64TH TER
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:
66102-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-678-6470
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2026