Provider First Line Business Practice Location Address:
529 SE 2ND ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64063-2646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-246-4884
Provider Business Practice Location Address Fax Number:
816-246-4884
Provider Enumeration Date:
06/16/2006