Provider First Line Business Practice Location Address:
2538 S. 65TH 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:
66106-5415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-375-1431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2007