Provider First Line Business Practice Location Address:
5601 NE ANTIOCH RD
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:
64119-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-453-7044
Provider Business Practice Location Address Fax Number:
913-677-2477
Provider Enumeration Date:
07/26/2006