Provider First Line Business Practice Location Address:
1225 N 78TH ST
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66112-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-299-9255
Provider Business Practice Location Address Fax Number:
913-299-0414
Provider Enumeration Date:
07/18/2014