Provider First Line Business Practice Location Address:
5863 NW 72ND 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:
64151-1483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-984-8280
Provider Business Practice Location Address Fax Number:
816-984-8281
Provider Enumeration Date:
02/08/2013