Provider First Line Business Practice Location Address:
712 W 48TH ST
Provider Second Line Business Practice Location Address:
APT 203
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64112-1885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-914-7219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2015