Provider First Line Business Practice Location Address:
1125 N 5TH 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:
66101-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-348-0888
Provider Business Practice Location Address Fax Number:
913-342-2644
Provider Enumeration Date:
03/17/2016