Provider First Line Business Practice Location Address:
5435 KANSAS AVENUE
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:
66106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-287-7171
Provider Business Practice Location Address Fax Number:
913-287-2919
Provider Enumeration Date:
07/13/2007