Provider First Line Business Practice Location Address:
6011 CENTRAL 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:
64113-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-444-2242
Provider Business Practice Location Address Fax Number:
816-444-8630
Provider Enumeration Date:
08/18/2006