Provider First Line Business Practice Location Address:
8575 N GRANBY AVE
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:
64154-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-468-4015
Provider Business Practice Location Address Fax Number:
816-468-4010
Provider Enumeration Date:
05/30/2013