Provider First Line Business Practice Location Address:
540 E 99TH 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:
64131-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-942-2884
Provider Business Practice Location Address Fax Number:
816-942-9153
Provider Enumeration Date:
03/22/2007