Provider First Line Business Practice Location Address:
40 S 18TH 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:
66102-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-1533
Provider Business Practice Location Address Fax Number:
913-912-1388
Provider Enumeration Date:
07/23/2013