Provider First Line Business Practice Location Address:
6406 E 87TH STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-763-3030
Provider Business Practice Location Address Fax Number:
816-965-9948
Provider Enumeration Date:
03/04/2008