Provider First Line Business Practice Location Address:
2828 N 17TH ST
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:
66104-5437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-223-9112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2026