Provider First Line Business Practice Location Address:
811 E 72ND 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:
64131-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-549-8282
Provider Business Practice Location Address Fax Number:
816-817-0657
Provider Enumeration Date:
12/01/2006